Garry Rayno's State House Dome: Medicaid remains big budget hurdle

The opening salvos were fired last week in the budget war between the House and Senate.

At budget negotiators' first meeting Friday, Senate Finance Committee Chairman Sen. Chuck Morse, R-Salem, attempted to take several of the key issues off the table: Medicaid expansion, tax and fee increases and puffing up revenue estimates to pay for additional spending.

Over the next four days there will be plenty of discussions about all three items, beginning with the key piece: Medicaid.

Gov. Maggie Hassan and the Democrats who control the House want the state to expand the state-federal health insurance program for the poor, disabled and elderly under the Affordable Care Act.

However, the Republican-controlled Senate wants to wait to "find a New Hampshire solution" while a commission studies the effect of expansion on the state.

Morse said the issue is far too complex to discuss in three days.

Later, Senate President Peter Bragdon, R-Milford, left the door open just a crack, saying he was willing to discuss changing the commission, its time frame for reporting and what it would study.

That is not going to satisfy the House or the governor or even several members of Bragdon's own Republican caucus who want to see something done that will expand health insurance coverage for state residents while the feds are footing the bill for the next three years.

Medicaid expansion has the support of hospitals that want to see some money for treating poor patients who do not pay their bills, though the hospitals would receive better compensation if private insurance covered those people not able to afford it.

The fight may not be settled in the budget, but the House and Hassan are certainly going to have to receive something in return, such as assurances something would be done early in January before letting that piece of the budget go.

If either side digs in their heels, that alone could blow up the budget and send bill drafting to the continuing resolution file, which would allow the state to operate after June 30 at this year's spending levels — not something many state agencies or the executive branch want.

The other big area of disagreement is a $50 million across-the-board cut in compensation and benefits, that would mean an estimated 700 layoffs for state workers.

The House upped its revenue estimates enough to nearly make up the $50 million reduction, but that is not likely to persuade Senate negotiators.

Chances are the House will agree to some reductions, but it will not be the $50 million the Senate wants.

Another area of contention is taxes.

Morse tried to end any discussion of tobacco or gas tax increases approved by the House when he said Senate Republicans would not support any tax or fee increases.

The Senate wants business tax credits to remain in place. They were passed last year but don't go into effect until the upcoming biennium. Hassan and the House want them delayed an additional two years.

The tax area is ripe for compromise, but just what that is will depend on how much revenue is needed for the budget.

Charter schools, school building aid and state help for local water and sewer projects are also areas of contention that need to be resolved but are certainly not insurmountable in the next three days.

A budget agreement is certainly achievable before the week is out, but only if the sides can agree on what to do with Medicaid expansion.

Medicaid expansion will be discussed by negotiators Monday, and that should give everyone a pretty good idea whether to expect a long hot summer in Concord or a cool summer breeze off the lake or ocean.

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Medicaid Expansion Push: Before the Senate voted on its budget this month, advocates for Medicaid expansion held press conferences and used every opportunity they could to push their cause.

Last week, the drumbeat continued, and it will keep going.

One of the advocacy groups, Granite State Progress, distributed a mailer in the districts of nine Republican senators asking residents whether they knew where their senator was sending their tax dollars and noting that if the residents didn't act, the money would go to other states.

The fliers ask voters to call their state senator to urge him or her to vote to expand Medicaid.

The senators targeted are Jeanie Forrester of Meredith, Jeb Bradley of Wolfeboro, Bob Odell of Lempster, Andy Sanborn of Bedford, David Boutin of Hooksett, Russell Prescott of Kingston, Nancy Stiles of Hampton, Bragdon and Morse.

Rallies will be held this week in Concord as well targeting the budget negotiations.

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What Could Have Been: The two major sources of new revenue proposed this session — a gas tax increase and casino gambling — are essentially dead during budget discussions, with little hope of anything more than a token increase in the gas tax or auto registrations to keep the Interstate 93 expansion project from Salem to Manchester moving forward.

Gambling is as dead as anything could be this time of year after the House killed Senate Bill 152 last month by a fairly significant vote.

"We committed the greatest mistake in the history of the state," said prime sponsor Sen. Lou D'Allesandro, D-Manchester. "The state gave away its ability to create thousands of jobs and enhance state revenues dramatically."

Last week, reports out of Maine indicated the Oxford Casino, just across the border from the Conway area, made about $65 million during its first year of operation, which netted Maine $23.8 million in state revenue.

The casino has 814 video slot machines and 22 table games, which is about a quarter of the size of the casino proposed under SB 152.

Clyde Barrow of the Northeast Gaming Research Project at the University of Massachusetts at Dartmouth said first-year results show the casino is a success.

Barrow was one of the experts the Joint House Gaming super committee heard while reviewing SB 152 before voting, 23-22, to kill it.

Bob Bahre, former owner of the New Hampshire International Speedway, is one of the principals in the development of the Oxford Casino, which was recently sold for $160 million to Churchill Downs Inc. Properties, which owns the home of the Kentucky Derby.

The Oxford Casino's success has revived discussions of a new racino — or combination racetrack and casino — at Scarborough Downs in Biddeford, Maine, with Ocean Properties involved in the proposed project. Ocean Properties renovated the Wentworth-by-the-Sea resort in New Castle.

"Now we have Maine and Massachusetts on our borders," D'Allesandro said. "We all know New Hampshire is the best place. We have the best access and egress, the center of population and the history of being a tourist destination."

He said with a casino in the southern area of the state, people would come here in record numbers.

D'Allesandro, a member of the Senate budget negotiating team, said a casino would have produced the revenue needed to pay for the things the House and Senate are fighting over.

"We gave up the best opportunity we've had since we put in the lottery," D'Allesandro said.

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Aging New Hampshire: While lawmakers are arguing over providing health insurance for the working poor through Medicaid expansion, maybe they should be talking about Medicare, nursing homes, community-based services and assisted living.

According to Governing, an organization that provides information to state and local elected officials and others, New Hampshire's median age grew faster than that in any other state since 2010.

While New Hampshire does not have the oldest median age for any state, the median age of Granite Staters increased from 41.2 years to 42 since 2010, or 8.7 percent.

New Hampshire is the third-oldest state in the nation, behind Maine at 43.5 years and Vermont at 42.3. West Virginia ranks fourth at 41.7 years.

According to Governing, some of the highest concentrations of older Americans can be found in New England.

The national median age is 37.4 years, up from 37.2 in 2010. Only North Dakota, Alaska, Kansas, Oklahoma and Washington, D.C., showed decreases in median age, according to Census Bureau figures.

Within New Hampshire, residents of Carroll and Coos counties have the highest median age, at 49.7 and 47.6, respectively, while Strafford and Hillsborough counties have the lowest, at 37.2 and 40.1 years, respectively.

Strafford County benefits from having about 15,000 students in Durham to bring down the median age.

Other counties with a large number of students — such as Grafton, with Dartmouth College and Plymouth State University, and Cheshire, with Keene State College — also have lower median ages, with Grafton at 42.1 years and Cheshire at 41.2.

Merrimack County, with the state capital, is a little bit older, at 42.4 years.

Some have been warning for a while that the state's aging population would bring problems. Maybe it's coming to fruition sooner than expected.

"The Fiscal Committee bypassed the budget process to spend $93 million without a single word of public input," said Rep. Josh Moore, R-Merrimack.

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